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A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia
Open accessAbstract
BACKGROUND: Antipsychotic medications often have a variety of side effects, however, it is not well understood how the presence of specific side effects correlate with adherence in a real-world setting. The aim of the current study was to examine the relationship between these variables among community-dwelling patients with schizophrenia. METHODS: Data were analyzed from a 2007-2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876). The presence of side effects was defined as those in which the patient reported they were at least "somewhat bothered". Adherence was defined as a score of zero on the Morisky Medication Adherence Scale. To assess the relationship between side effects and adherence, individual logistic regression models were fitted for each side effect controlling for patient characteristics. A single logistic regression model assessed the relationship between side effect clusters and adherence. The relationships between adherence and health resource use were also examined. RESULTS: A majority of patients reported experiencing at least one side effect due to their medication (86.19%). Only 42.5% reported complete adherence. Most side effects were associated with a significantly reduced likelihood of adherence. When grouped as side effect clusters in a single model, extra pyramidal symptoms (EPS)/agitation (odds ratio (OR) = 0.57, p = 0.0007), sedation/cognition (OR = 0.70, p = 0.033), prolactin/endocrine (OR = 0.69, p = 0.0342), and metabolic side effects (OR = 0.64, p = 0.0079) were all significantly related with lower rates of adherence. Those who reported complete adherence to their medication were significantly less likely to report a hospitalization for a mental health reason (OR = 0.51, p = 0.0006), a hospitalization for a non-mental health reason (OR = 0.43, p = 0.0002), and an emergency room (ER) visit for a mental health reason (OR = 0.60, p = 0.008). CONCLUSIONS: Among patients with schizophrenia, medication side effects are highly prevalent and significantly associated with medication nonadherence. Nonadherence is significantly associated with increased healthcare resource use. Prevention, identification, and effective management of medication-induced side effects are important to maximize adherence and reduce health resource use in schizophrenia.
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“Likewise, in five studies, weight gain was another medication-related side-effect that associated with medication non-adherence and patients’ perception toward their medication [25, 33, 36, 44, 55].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [33]
In the citing paper
“In seven studies, patients feeling dizziness, fatigue, tiredness, sedation, lethargy, and sleepiness were the most frequently reported side-effects that contributed to medication non-adherence [11, 33, 36, 37, 50, 52, 65].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [33]
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“In two studies, side-effects such as decreased sexual interest and having a symptom of sexual dysfunction were associated with patients’ medication adherence [33, 36].”
From Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis (2020) · cites this paper as [33]
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InfluentialThe nocebo effect: a clinical challenge in the era of biosimilars
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“Therefore, LAI risperidone improved the adherence to treatment and decreased the relapse rate in FEP patients more than oral antipsychotics, a key factor in the treatment of psychotic disorders (Dibonaventura et al., 2012; Hasan et al., 2013).”
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“Negative previous experiences with medication, such as non-response [27] or severe side effects [28] are also likely to influence the decision of whether to accept medication as does a generalized critical attitude towards medication [4,29,30].”
BackgroundTreatment outcomes in schizophrenia: qualitative study of the views of family carers
Lloyd, J., Lloyd, H. M., Fitzpatrick, R. M., & Peters, M. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1418-8 · Cited by 26
Jørgensen, K. T., Bøg, M., Kabra, M., Simonsen, J., Adair, M., & Jönsson, L. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03634-z · Cited by 28
“This study provides further evidence of the progressive nature of schizophrenia, and emphasises the importance of providing early, effective, and tolerable treatment options that better meet a patient’s individual needs, to enable treatment adherence, recovery and prevent future relapses, which is consistent with prev…”
ResultHendrychova, T., Vytrisalova, M., Smahelova, Vlček, J., & Kubena (2013) · Patient Preference and Adherence · doi:10.2147/ppa.s47750 · Cited by 25
“12,18 In contrast to other chronic diseases, 31,32 adherence in adults with type 1 diabetes did not correlate with adverse events during treatment.”
Liu, Y., Wang, R., Huang, R., Cao, Y., Wang, J., & Feng, D. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-043557 · Cited by 25
Givens, C. (2016) · Nursing Clinics of North America · doi:10.1016/j.cnur.2016.01.013 · Cited by 25
Reduced sexual dysfunction with aripiprazole once-monthly versus paliperidone palmitate
Potkin, S. G., Loze, J.-Y., Forray, C., Baker, R. A., Sapin, C., Peters-Strickland, T. S., Beillat, M., Nylander, A., Hertel, P., Andersen, H. S., et al. (2017) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000168 · Cited by 24
“Furthermore, patients with schizophrenia who report side effects are less likely to adhere to medication (Dibonaventura et al., 2012).”
BackgroundBahta, M., Ogbaghebriel, A., Russom, M., Tesfamariam, E. H., & Berhe, T. (2021) · Annals of General Psychiatry · doi:10.1186/s12991-021-00348-0 · Cited by 24
“Association of specific adverse effect categories and non-adherence found in the present study is in line with some studies, which reported extrapyramidal [9, 15, 21, 22], hormonal [8, 9, 15], psychic [8, 9, 15, 18], and miscellaneous reactions such as weight gain [9] as determinants of non-adherence.”
ResultZhou, Y., Rosenheck, R., Mohamed, S., Ning, Y., & He, H. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.036 · Cited by 23
“Thirdly, medication side effects were not assessed in the present study, which previous research suggests can be an important reason for non-adherence to prescribed mediation regimens (Dibonaventura et al., 2012).”
BackgroundSchwarz, C., Schulte-Hubbert, B., Bend, J., Abele‐Horn, M., Baumann, I. G., Bremer, W., Brunsmann, F., Dieninghoff, D., Eickmeier, O., Ellemunter, H., et al. (2018) · Pneumologie · doi:10.1055/s-0044-100191 · Cited by 24
Palapar, L., Kerse, N. M., Rolleston, A. K., den Elzen, W. P. J., Gussekloo, J., Blom, J. W., Robinson, L. A., Martin-Ruiz, C. M., Duncan, R. C., Arai, Y., et al. (2020) · Age and Ageing · doi:10.1093/ageing/afaa178 · Cited by 24
4-Methoxycinnamic acid attenuates schizophrenia-like behaviors induced by MK-801 in mice
Jeong, Y., Bae, H. J., Park, K., Bae, H. J., Yang, X., Cho, Y.-J., Jung, S. Y., Jang, D. S., & Ryu, J. H. (2021) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2021.114864 · Cited by 23
Explaining Attitudes and Adherence to Antipsychotic Medication: The Development of a Process Model
Wiesjahn, M., Jung, E., Lamster, F., Rief, W., & Lincoln, T. M. (2014) · Schizophrenia Research and Treatment · doi:10.1155/2014/341545 · Cited by 23
“In support of this explanation, recent studies in patientswith psychotic disorders [20, 21] and in other populations [22] applied standardized assessments of side effects and found them to be consistently related to lower medication adherence.”
ResultGirma, S., Abdisa, E., & Fikadu, T. (2017) · Health Science Journal · doi:10.21767/1791-809x.1000520 · Cited by 22
“Similarly another study indicated patient having extra pyramidal and psychic side effects and sedation were found to be statistically significantly associated with non-adherence [23].”
ResultPu, Z., Sun, Y., Jiang, H., Hou, Q., Yan, H., Wen, H., & Li, G. (2021) · The American Journal of Chinese Medicine · doi:10.1142/s0192415x21500920 · Cited by 23
A psychological flexibility model of medication adherence in psychotic-spectrum disorders
Moitra, E., & Gaudiano, B. A. (2016) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2016.10.003 · Cited by 24
Gault, I., Gallagher, & Chambers (2013) · Patient Preference and Adherence · doi:10.2147/ppa.s44894 · Cited by 21
“Although many mental health service users are prone to nonadherence, most concern around nonadherence is directed at severe mental illnesses such as schizophrenia.(4) A review of the literature concludes that the situation has not improved over the past 30 years.”
BackgroundMedication Management Frameworks in the Context of Self-Management: A Scoping Review
Cadel, L., Cimino, S. R., von den Baumen, T. R., James, K. A., McCarthy, L. M., & Guilcher, S. J. T. (2021) · Patient Preference and Adherence · doi:10.2147/ppa.s308223 · Cited by 20
Matsuda, M., & Kohno, A. (2016) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2016.03.008 · Cited by 30
Ibrahim, W, A., Pindar, K, S., Yerima, M, M., Rabbebe, B, I., Shehu, S, et al. (2015) · Journal of Neuroscience and Behavioral Health · doi:10.5897/jnbh2015.0128 · Cited by 20
“These medication-related factors include dosing regimen, side effect profiles, fear of addiction potentials, and concerns about drug-drug interactions (Weiden and Miller, 2001; DiBonaventura et al., 2012; Higashi et al., 2013; Caldeira et al., 2014; Eticha et al., 2015).”
BackgroundResultBegum, F., Mutsatsa, S. H., Gul, N., Thomas, B., & Flood, C. (2020) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12600 · Cited by 21
Schizophrenia through the carers' eyes: results of a European cross‐sectional survey
Svettini, A., Johnson, B., Magro, C., SAUNDERS, J. R., Jones, K., Silk, S., Hargarter, L., & Schreiner, A. (2015) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12209 · Cited by 19
Kadakia, A., Brady, B. L., Dembek, C., Williams, G. R., & KENT, J. M. (2021) · Journal of Medical Economics · doi:10.1080/13696998.2021.2019501 · Cited by 19
Verkooyen, R., Broers, N. J., & Dandachi-FitzGerald, B. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1378456 · Cited by 18
Mallet, J., Gorwood, P. A. P. M., Strat, Y. L., & Dubertret, C. (2019) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyz043 · Cited by 18
A clinical communication tool for the assessment of psychotropic medication side effects
Ashoorian, D. M., Davidson, R. M., Rock, D. J., Dragović, M., & Clifford, R. M. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.10.022 · Cited by 18
“%) will discontinue pharmacological treatment potentially leading to illness relapse and re-hospitalization (DiBonaventura et al., 2012; Morrison et al., 2000; Lambert et al., 2004).”
Kauppi, K., Hätönen, H. M., Adams, C. E., & Valimaki, M. A. (2014) · Journal of Advanced Nursing · doi:10.1111/jan.12567 · Cited by 17
Sun, Y., Wang, M., Zhou, Y., Wang, L., Zhang, H., Lv, Y., & Li, G. (2018) · Psychology Health & Medicine · doi:10.1080/13548506.2018.1533248 · Cited by 19
“…reported to be associated with medication adherence includes symptoms(Katherine, Clifford, Mark, Ridha, & Ashork, 2012)，attitudes and low insight (Misdrahi, Petit, Blanc, Bayle, & Llorca, 2012), family support (Glick, Stekoll, & Hays, 2011) and medication side effects (Dibonaventura et al., 2012).”
BackgroundLiberato, A. C. S., São‐João, T. M., Jannuzzi, F. F., Landaas, E. J., Wongchareon, K., & Rodrigues, R. C. M. (2020) · Value in Health Regional Issues · doi:10.1016/j.vhri.2020.07.578 · Cited by 17
Prospects of Probiotic Adjuvant Drugs in Clinical Treatment
Ren, Z., Hong, Y., Huo, Y., Peng, L., Lv, H., Chen, J., Wu, Z., & Wan, C. (2022) · Nutrients · doi:10.3390/nu14224723 · Cited by 17
“Currently, drug therapy is the most common means of remission in humans [3,4], but some are not particularly effective, or they cause additional damage to the body [5,6].”
BackgroundGroup art therapy as adjunct therapy for the treatment of schizophrenic patients in day hospital
Mandić-Gajić, G. (2013) · Vojnosanitetski pregled · doi:10.2298/vsp1311065m · Cited by 17
Patel, R. S., Sreeram, V., Vadukapuram, R., & Baweja, R. K. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.11.002 · Cited by 16
Sun, Y., Hasbi, A., & George, S. R. (2025) · The Annual Review of Pharmacology and Toxicology · doi:10.1146/annurev-pharmtox-061724-080727 · Cited by 18
Dopamine partial agonists: a discrete class of antipsychotics
Taylor, D. M., Chithiramohan, R. N., Grewal, J., Gupta, A., Hansen, L. K., Reynolds, G. P., & Pappa, S. (2022) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2022.2151473 · Cited by 15
“Sedation is a side effect that is commonly strongly disliked by patients and their carers (Bourin & Briley, 2004; Dibonaventura et al., 2012) but it is often seen as beneficial particularly in the acute settings by clinicians though usually unnecessary and disadvantageous in the medium to long-term.”
BackgroundThe impact of antipsychotic adherence on acute care utilization
Perkins, A. J., Khandker, R. K., Overley, A. M., Solid, C. A., Chekani, F., Roberts, A., Dexter, P. R., Boustani, M. A., & Hulvershorn, L. A. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04558-6 · Cited by 15
Bae, H. J., Kim, J. Y., Choi, S., Kim, S.-Y., Kim, H. J., Cho, Y. E., Choi, Y.-Y., An, J.-Y., Cho, S.-Y., Ryu, J. H., et al. (2023) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2023.116627 · Cited by 15
Collins, J. C., Wheeler, A., McMillan, S. S., Hu, J., El‐Den, S., Roennfeldt, H., & O’Reilly, C. L. (2024) · Health Expectations · doi:10.1111/hex.70122 · Cited by 15
“Side effects, such as weight gain, perceived impairment of cognition and sedation, may be so bothersome that people may choose to stop taking their medications, putting them at an increased risk of relapse and hospitalisation [10 – 13].”
Metadata
- Authors
- DiBonaventura, M., Gabriel, S., Dupclay, L., Gupta, S., & Kim, E.
- Affiliations
- Kantar Health (United States) (US)
- Novartis (United States) (US)
- Corresponding author
- DiBonaventura, Marco
- Venue
- BMC Psychiatry
- Published
- 2012-03-20
- Volume
- 12
- Issue
- 1
- Pages
- 20-20
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3342101
- OpenAlex
- W2157910519
- Cited by
- 333
- References
- 31
- Citations by year
- 2026: 16 · 2025: 30 · 2024: 32 · 2023: 27 · 2022: 22 · 2021: 34 · 2020: 22 · 2019: 27 · 2018: 22 · 2017: 20 · 2016: 24 · 2015: 22 · 2014: 13 · 2013: 19 · 2012: 2
- FWCI
- 15.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- schizophrenia, antipsychotic adverse effects, medication adherence, medication non-adherence, sedation, prolactin, metabolic side effects, health care utilization, hospitalization, emergency department visits, patient perspectives, community-dwelling patients, Morisky Medication Adherence Scale, health care costs, quality of life
- MeSH terms
- Adult, Attitude to Health, Cross-Sectional Studies, Female, Health Surveys, Humans, Male, Middle Aged, Schizophrenia, Schizophrenic Psychology, Antipsychotic Agents, Medication Adherence
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